The quality of care of diabetic patients in rural Malawi: A case of Mangochi district

Background Diabetes mellitus is a global public health problem. In Malawi, the prevalence of diabetes is 5.6% but the quality of care has not been well studied. Objective The aim of this study was to assess the quality of care offered to diabetic patients in Mangochi district. Methods This was a cross sectional descriptive study. Quantitative data were collected using a questionnaire from a sample of 75 diabetic patients (children and adults) who attended the Diabetes Clinic at Mangochi District Hospital between 20012 and 2013. Qualitative data were also collected using semi-structured interviews with eight Key Informants from among the District Health Management Team. Frequencies and cross-tabulation were obtained from the quantitative data. Patients’ master cards were checked to validate results. Clinical knowledge about diabetes, care practices and resources were the themes analysed from the qualitative data. Results Among the 75 participants interviewed, 46 were females and 29 males. The overall mean age was 48.3 years (45.6 for females and 53.3 for males). More than half of patients had little or no information about diabetes (40.0 % (n=30) and 22.7 (n=17) respectively. The majority of patients were taking their medicines regularly 98.7% (n=74). Only 17.3% (n=13) reported having their feet inspected regularly. Fifty-six percent of patients were satisfied about services provision. Some nurses and clinicians were trained on diabetes care but most of them left. Guidelines on diabetes management were not accessible. There were shortages in medicines (e.g. soluble insulin) and reagents. Information Education and Communication messages were offered through discussions, experiences sharing and posters. Conclusion Quality of diabetes care provided to diabetic patients attended to Mangochi hospital was sub-optimal due to lack of knowledge among patients and clinicians and resources. More efforts are needed towards retention of trained staff, provision of pharmaceutical and laboratory resources and health education.

DETERMINANTS OF THE ADOPTION OF INTEGRATED SOIL FERTILITY MANAGEMENT TECHNOLOGIES IN MBALE DIVISION, KENYA

The agro-climatic conditions in western Kenya present the region as a food surplus area yet people are still reliant on food imports, with the region registering high poverty levels. Depletion of soil fertility and the resulting decline in agricultural productivity in Mbale division has led to many attempts to develop and popularize Integrated Soil Fertility Management (ISFM) technologies that could restore soil fertility. These technologies bridge the gap between high external inputs and extreme forms of traditional low external input agriculture. Some of the ISFM components used by farmers are organic and inorganic inputs and improved seeds. However, the adoption of these technologies is low. The study aimed to examine the factors that influence the adoption of ISFM technologies by smallholder farmers in Mbale division, Kenya. The study was conducted in 9 sub-locations in Mbale division. Purposive sampling was used in selecting the 80 farmers to get the data based on a farm-household survey. Self-administered questionnaires were used to collect data on the determinants of the adoption of ISFM technologies from the sampled farmers in the study area. The study sought to answer the research question: What factors influence the uptake of ISFM technologies by farmers in Mbale division? The hypothesis tested was that the adoption of ISFM technologies is not influenced by age, education, extension services, labour, off-farm income and farm size. Data was analyzed using descriptive statistics. Cross tabulation was used for examining the relationship between categorical (nominal or ordinal) variables, and the bivariate correlations procedure was used to compute the pair wise associations between scale or ordinal variables. Probit regression was used to predict the socio-economic factors influencing the adoption of ISFM technologies among smallholder farmers. Results of the study indicated that education of household head, membership in social groups, age of the household head, off-farm income and farm size were the variables that significantly influenced the adoption of ISFM technologies. The findings show that there is need for a more pro-poor focused approach to achieve sustainable soil fertility management among smallholder farmers. The findings will help farmers, extension officers, researchers and donors in identifying region-specific entry points that can help in developing innovative ISFM technologies.